ASPO Abstracts
Clinical Documentation of Tobacco Use in Pediatric Practice: Challenges and Opportunities
Category: Behavioral Science & Health Communication
Conference Year: 2019
Abstract Body:
Purpose: To describe tobacco use and tobacco smoke exposure (TSE) documentation practicesin pediatric clinics.Methods: Using a convergent mixed-methods study design, we conducted an electronic healthrecord (EHR) review of 508 well-child visits among adolescents (aged 11-17) and in-depth qualitativeinterviews with a subset of 16 adolescents at four pediatric primary care clinics from July 2016 to November2017. Records were assessed for documentation of tobacco use, TSE, and provision of tobacco-relatedcounseling for adolescents and parents. Interviews collected adolescents’ perspectives on and history oftobacco use, and tested usability of an electronic clinical support tool emphasizing screening for use ofspecific cigarette and non-cigarette tobacco products. Record review data and interview transcripts were analyzedand interpreted concurrently using iterations of deductive and inductive coding, following a team-basedcoding approach to ensure high inter-rater reliability.Results: Cigarette use screening was documented in 92.3% of visits and smokeless tobaccouse screening in 51.4% of visits. Lower rates of assessment for parental tobacco use (23.2%), home TSE(33.1%), and vehicle TSE (22.4%) were found. Providers documented advising against tobacco use in 6.5% ofvisits. Multiple tobacco-related prompts were identified. Smoking status response options were not mutuallyexclusive and did not include non-cigarette tobacco/nicotine products or TSE. No records documentedassessment of e-cigarette or hookah use, despite nearly half of adolescent interview respondents citing these as theproducts most commonly used by teens. In interviews, adolescents discussed their experiences withalternative tobacco/nicotine products more than cigarettes. Conclusions: Tobacco use status prompts should be revised for clarity and includenon-cigarette tobacco products and TSE. Provider education on the importance of e-cigarette, hookah, and TSEassessment in adolescents is needed. Improvements in EHR systems, resources, and tools can lead tobetter tobacco screening, prevention, and treatment practices among primary care providers.
Keywords: tobacco, tobaccosmoke exposure, electronichealth record